Age Related Macula Degeneration – AMD

 

Age related macula degeneration (AMD) is a very common cause of blindness amongst the elderly population. Utilizing US census data physicians have estimated by 2020 almost 3 million people were likely to develop AMD. Constant research is occurring to search for more advanced therapies to treat this condition.

AMD is often divided into wet and dry. Dry macula degeneration is far more common. Its presence is dedicated by a dilated eye exam. Wear and tear changes build up in the very metabolically active macula (the center part of your vision) at the back of the eye in patients over 50 years of age. Some AMD patients have genetic predispositions to developing their disease. Other patients have modifiable risk factors that they can control to help slow the progression of their condition. The most important of these is smoking, as smoking is known to accelerate disease progression. Other factors in your control include maintaining good blood pressure and exercise.

Wet AMD occurs when new blood vessels grow underneath the retina. These leak fluid and bleed potentially causing rapid changes in central vision. Thankfully treatment of this condition has been revolutionized by injections delivered inside the eye painlessly. In many cases sight can be preserved with prompt treatment.
Historically, only destructive laser treatments were available that attempted to limit disease progression of wet AMD. Research showed that immature new vessel networks like those found in wet AMD need a biochemical called vascular endothelial growth factor (VEGF) to grow and thrive. Originally used for colon cancer, Avastin was one of the first anti-VEGF to be injected into eyes. The results were a dramatic reduction in activity of the new blood vessels networks, limiting their bleeding and fluid leakage and either restoring or preserving vision in a lot of patients. Now there are 2 other anti-VEGF medications available to use in addition to Avastin. Choice is physician dependent and good arguments can be made to select all three.

If you are identified as having wet AMD you will typically be recommended to receive monthly treatments by your retina doctor until your disease is under control. At this point many physicians extend treatment, this attempts to reduce treatment burden whilst keeping the eye safe. A lot of patients can be safely extended, some have new vessel networks that need more medication to treat, and cannot safely be extended. In the future sustained release medications may become available reducing treatment burden for many patients.
Developments in AMD are occurring all the time, new ways to monitor for progression (including home monitoring), new technology to detect wet AMD earlier, and in the future surgical intervention with stem cell therapies are all in progress. If you are older than 50 and have a family history of AMD talk to your eye care provider about getting screened for AMD.

 

Henry Holt, M.D.

1801 N. H. Medical Park Drive

Wilmington, N.C. 28403

Myopia and the Macula

Nearsighted individuals can develop problems in the center part of the vision. Very nearsighted individuals can develop thinning in the macula which is the center part of the retina. The macula is necessary for our finest detailed vision. Sometimes the thinning can disturb one of the layers of the retina which functions as a barrier between the underlying blood vessels in the choroid and the retina itself. Just like cracks in a pavement these thin areas can grow ‘weeds’ (new blood vessels). In fact a lot of pathologies in the macula that we treat have as there common path new blood vessel formation. Wet macular degeneration patients being the obvious example, here new blood vessel formation results from progressive degenerative change where age is the greatest risk factor.

The good news for myopic individuals is oftentimes their prognosis is better for their macula degeneration compared with their wet AMD counterparts. Patients with myopic choroidal neovascularization (new blood vessel formation or cnv) may experience distortion or a blur in their central vision. Oftentimes patients in this situation are extremely sensitive to any changes in their vision. If a patient has myopic CNV the standard of care is intravitreal medications (medications delivered inside the eye). Thankfully myopic patients often respond very well to treatment and can continue to enjoy good central vision for a long period of time. If you are extremely nearsighted it is important to get regular eye checks and if your ophthalmologist suspects myopic macular degeneration a retina specialist evaluation is always reasonable.

Henry Holt, MD
1801 N.H. Medical Park Drive
Wilmington, N.C. 28403

HURRICANE FLORENCE CLOSING

Due to the projected impacts from Hurricane Florence, Retina of Coastal Carolina’s Wilmington office will close at noon on Wednesday, September 12 and remain closed Thursday, September 13 and Friday, September 14. Our location in Jacksonville will remain closed through Monday, September 17. Please check our website for updated closing information. Our answering service can be reached by calling our main number (910) 254-2023.

Myopia – Retina Pathologies and Treatments

 

 

Should everybody with peripheral retinal pathology be treated?

This is controversial. The best data that we have would indicate it is reasonable to observe a lot of peripheral retinal pathology as the amount of subsequent retinal detachments are infrequent therefore one would have to treat a lot of patients to prevent one retinal detachment. However if you ask any retinal surgeon which they would prefer to treat; an atrophic hole with laser in the office or a retinal detachment in the operating room I know which one they would opt for!

So how do we decide?

I tend to treat patients that are symptomatic with flashing lights, or who have had a retinal detachment in the other eye, or who have a strong family history of retinal detachment. The risk of laser is minimal so I also offer each patient with peripheral pathology the option of prophylactic laser. Regardless of the decision to treat or observe nearsighted individuals should follow regularly with an ophthalmologist. And those that have peripheral retinal pathology should see a retina specialist once a year.

Henry Holt, MD
1801 N.H. Medical Park Drive
Wilmington, N.C. 28403

Myopia and the Retina

Myopia is a refractive state where the light entering the eye is focused naturally before the retina. It can either be refractive which is often due to the shape of the cornea, or it can be axial which is related to the length of the eye. Most people in a retinal office have axial myopia. Their eye is longer than average. As a consequence the retina is thinner than average. This can cause a number of different issues.

In the periphery degenerative holes or thin areas in the retina (lattice degeneration) can form leading to chronic retinal detachment. In the center of the retina, the macula, degenerative changes and thinning of the retina can lead to new blood vessel formation which can cause irreversible central loss of vision.

Who is at risk?

Although there is no definitive cutoff pathological myopia is defined as a prescription of greater than minus 8D. In practice anyone with myopia and a family history of retina issues should get screened by an ophthalmologist to ensure their eye is healthy.

Henry Holt, MD
1801 N.H. Medical Park Drive
Wilmington, N.C. 28403

Many Options for Diabetic Eye Treatment

 

Everywhere there are articles about the epidemic of diabetes in the world. The US has the highest prevalence of diabetes of developed countries. As a retina surgeon, I see the misery that this disease causes. My diabetic patients not only are on their way to blindness, but many of them are on dialysis, have lost legs, and suffer from many other unpleasant conditions. Fortunately in diabetic eye treatment, there have been many breakthroughs.

The most common cause of blindness in diabetics is swelling of the macula, the center part of the retina. This happens when the glucose level exceeds the normal level and damages the walls of the blood vessels. The traditional treatment was to laser where the leaks were and this worked well. However the average result was that the vision stayed the same so any vision that was lost before the laser treatment was permanent. Today we have antigrowth hormones that block the pathway that starts the damage and this allows the body to heal. The injections are placed through the white part of the eye and are usually given every one to three months. The vision often improves. The other amazing finding is that the severity of the disease decreases after several years of treatment. Treated patients are less likely to need more aggressive treatment like laser or hospital surgery.

Other drugs that decrease the swelling are corticosteroids, a prednisone like medication. These come in the form of slow release pellets lasting from a few months to one that lasts up to three years. I find these very helpful for patients that have difficulty with the rather strict appointment schedule. Some patients after stabilization with the antigrowth hormone drugs do well with the long acting corticosteroid pellet. Patients have a lot of anxiety about eye injections and they are relieved to have an injection that lasts years. Unfortunately for the patient with a lot of damage, these do not work as well as the antigrowth hormones.

Although we use the laser much less than 10 or 20 years ago, it is still vital for many patients. A newer laser, micropulse, stimulates the pumps in the retina to pump out fluid from the leaky diabetic vessels. It is great for patients that have mild amounts of fluid and don’t want to start injections. It is also useful for patients that have had some of the antigrowth injections and are reluctant to keep going. The results are not as good as with a strict injection schedule but still very worthwhile.

Earlier treatment still results in better vision. A large number of diabetic patients are still not seen promptly. Many don’t go for an eye exam when they are diagnosed with diabetes and also miss their annual exam. Patients may not understand the importance of the eye exams because diabetic damage does not cause symptoms until it is severe. The new treatments will prevent an epidemic of blindness only if used in time.

Igor Westra MD
Retina of Coastal Carolina
1801 New Hanover Medical Park Dr., Wilmington, NC 2840

ROCC Employee Recognition

Our employee of the quarter is Sarah. She is a smiling face at our front desk and works all ROCC locations. Sarah was nominated by co-workers for her great attitude and eagerness to offer assistance to patients and co-workers. Sarah has many talents and stays busy outside the office with neighbors, friends, her husband and her dog Pepper. Thank you Sarah for being a vital piece of the ROCC team.

ASRS 2018

 

 

Retina of Coastal Carolina’s Management Team members were among the over 400 physicians and managers who attended the 20th Annual ASRS Business of Retina meeting in Dallas, Texas. The American Society of Retina Specialists sponsors this opportunity for attendees to obtain coding and regulatory updates, discuss strategies for enhancing practice efficiencies and network with other retina providers. We learn together, commiserate together over constantly changing governmental regulations, anguish over obstacles to patient care by insurers as well as deal with the ongoing challenges of running a business. Thanks to our physicians for this educational opportunity.

A Look Back And Ahead…

As we close 2017 and await new opportunities to come, we want to express gratitude for all our blessings and best wishes for the new year. We are thankful for our staff, our patients and providers that we are pleased to work with in our efforts to deliver the highest level of retina care. Our annual open house provided an opportunity to thank our referring providers for their trust in our staff, and for each of us to kick off the holiday season.

 

2018 marks the beginning of the 21st year of Retina of Coastal Carolina. Dr. Igor Westra started the practice in 1997 after seeing the expanding need for retina care. 2017 brought new staff to ROCC, including the addition of Dr. Henry Holt. As Dr. Holt joins the provider staff, Dr. Erik van Rens, who came to ROCC in 1998, takes a little step back from his work duties to allow more time for family and other interests.
Continuing changes in treatment and diagnosis capabilities present challenges and opportunities. Our goal remains to ‘provide the best in retina care’.

Physician and Staff attend American Academy of Ophthalmology Joint Meetings

Each fall, ophthalmologists from around the world together with staff members congregate to enhance their knowledge and share experiences at meetings held by the American Academy of Ophthalmology (AAO), its Executive Branch (AAOE) and the Joint Commission on Allied Health (JCAHPO). This year’s meetings were held in New Orleans. Continuing our tradition of enhancing our staff knowledge through continuing education, Dr. Erik van Rens, our Financial Manager, and three of our experienced certified ophthalmic assistants made the trip to take part in this opportunity. We were able to experience a little of the Big Easy outside of class time while interacting with other retina and teaching staff to continue our goal of providing the best in retina care to our patients.